| NPI | 1811316128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 286342-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.130983) |
| 208D00000X General Practice (Licence: NY 286342-1) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2020-04-09 |